Organization
PENDLETON FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY LEE SMITH M.D. (OWNER/PHYSICIAN)
(864) 646-7522
Entity
Organization
Contact information
Practice address
101 SHIRLEY ST, PENDLETON, SC 29670-1824
(864) 646-7522
(864) 646-3377
Mailing address
PO BOX 547, PENDLETON, SC 29670-0547
(864) 646-7522
(864) 646-3377
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3375
—
SC
Enumeration date
07/20/2006
Last updated
08/07/2007
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